Practicing patience, church services, and becoming Ghanaian

Unfortunately, I still have not heard anything back from the Yale IRB about my research proposal. At this point, we are stalled. We want to print our posters and keep doing school talks, but I can’t carry out the research part of it until I get approval. Perhaps, like my project in Vietnam, this just needs to go on the back burner for a bit. “All of God’s leaders are prepared on a slow cooker,” stated the visiting pastor at the church I went to last Sunday, with one of my friends from work, so maybe these stalled projects are just part of my leadership development. They have to be prepared on the slow cooker.

I have now attended two church services, each of the last two Sundays. Depending on travel plans, I may or may not have time for more. I also went to a wedding on Saturday, and will likely go to another.

The church services are interesting. Sometimes very confusing, always with powerful messages, and about half of the time I feel a little flummoxed about how to respond to the choruses of “Amen” and “You are blessed” and “Hallelujah”.

I think the people I’ve gone with know that I’m not Christian. I know some of the ladies at work wanted to convert me, so maybe that’s part of the motivation behind inviting me, but I think it’s more that they wanted me to see their communities, the things that are important to them.

The first one I went to was on Father’s Day, and the sermon was about appreciation of fathers. It was difficult to hear, both because the mic was quiet and because the accent was thick, but I remember thinking that what I could hear was well said and an important message. Meghan went with me and we were confused by the number of offerings, and how we all had to proceed one-by-one up to the front… three times! We didn’t have the hymnal or a bible to look at, so we just sat and stood along with everyone else, but otherwise were very uninvolved.

The service I went to this past weekend was much easier to follow. It was also more fun! The first service was at a Methodist church and the more recent one was at a Pentecostal church. I know the basics of Christianity and many of the stories, but I don’t know the distinctions between branches, so it was interesting to compare them.

The Pentecostal service had much more singing and dancing, and the energy generated and shared between the church members was almost palpable. I could see that it was very valuable for generating and strengthening the community connection and the connection they feel to God.

The sermon was on leadership, and the service included a few minutes of bible study with the story of Joseph. I feel like I know the story of Joseph well from hearing the story as a child and from the well known musical, Joseph and the Amazing Technicolor Dreamcoat. The bible study was for the part of the story where Joseph goes from being sold into slavery to elevation within Potiphar’s house and the sermon was about the same. I agreed with a lot of what was said, but every time they said something about needing to have faith in God to be a good leader, I cringed a bit. Serving the people you want to lead, yes, being “prepared on the slow cooker” instead of the “microwave,” yes, but no, I don’t think it’s necessary to be Christian and be blessed by God.  The people were all very nice and welcoming, and asked when I would come back, but I don’t think I’ll have a chance during my remaining three weeks. I promised another Pastor that I would try to go to his church, which is near the house, so if I’m going anywhere other than Eric’s church, it’ll be that other Pastor’s church.

I went to a wedding on Saturday with Eric, who had been invited by a teacher at the school where he’s the headmaster and it was her sister who was getting married. The service was all in Twi, so I didn’t understand much, but fortunately there was a program, and it was in English. We also didn’t stay for the whole thing, because Eric had to get back to his music rehearsal. The part we stayed for was interesting. I’m fairly certain that there were several pictures taken of me just because I’m obruni… and I was the only one there. There were offerings during the service, and while photography from the guests is common in the US, Ghana goes above and beyond, with people getting out of their chairs and getting right in the faces of the bride and groom as they exchange vows and rings and have their first kiss as a married couple. I just hid in the back as much as possible and stood and sat with everyone else. It will be interesting to compare it to the other one that I will likely go to in two weekends’ time, with Adam (my classmate from Yale), who was invited by one of his coworkers.

Exchanging of rings, with all sorts of cameras in their faces.

On Monday, Grace and I went for an outreach clinic to a small community called Ofaakor. They have a tiny one-room clinic where the members of the community can go so that they don’t have to try to get all the way to the Kasoa Health Center, and two of the regular KHC nurses work there (rotating out each month), and the head nurse goes once a week to do check-ups of pregnant women. We learned how to do an exam of a pregnant woman and determine based on where the baby is sitting internally how far along the mother is. We listened to fetal heartbeats through a horn-like apparatus that we placed against the mother’s abdomen and checked for anemia, varicose veins, nipple suitability for suckling, and edema. We felt the craniums of several babies through the mothers’ abdomens and saw one that was breached (but early enough for it to be corrected before delivery).

And then something very unexpected happened.

Mothers in Ghana often (usually?) deliver at home, especially in the community we were in. However, one of the mothers we had examined early in the morning started showing labor signs before she left, so the head nurse (who is also called Grace) said she would deliver the baby at the clinic. Grace the fellow volunteer had said only a few minutes before that she wanted to see a birth, and she didn’t have to wait long. The mother came back in to the exam cubicle and Grace-the-nurse broke her water and told us that she was 5 cm dilated, so they cleaned her up and gave her a makeshift pad/underwear and she walked around for a bit to encourage the labor along. About 30 minutes or an hour later, it was time. She went into the exam cubicle for the last time and nurse Grace set her up with an IV and after a few minutes, volunteer Grace and I were called in. It all seemed to happen so quickly. I was in the room and watched my sister’s birth when I was six years old, but I don’t remember it particularly well. I feel like it did not go that quickly, though. It seemed like the mother pushed once and the head came halfway out, then once more and all of the rest of the baby’s body slipped out, with the actual delivery lasting less than a minute. The umbilical cord was tied off with string because they didn’t have clamps, and we stayed in the room for the delivery of the placenta and while the uterus was massaged to encourage it to contract to prevent profuse bleeding.

We were wondering how long the mother would stay in the room and at the clinic, but while we were still in the exam room with the first mother we heard that another had come in, ready to deliver. From having never delivered any babies at the clinic to two in one day. It was truly an unusual day. Volunteer Grace and I held both of the babies and took pictures with them and with their mothers. I wish I could stay long enough to watch these babies grow, to see them as they progress through the months and years, and then to tell them later that I was there when they first entered the world. It was incredible.

Me with the baby we saw the birth of and Grace holding the baby with the mother (below). 

Tuesday was far less eventful, but we had another school talk, and this time Grace and I were on our own, because Eric was at a conference. Emmanuel, a Ghanaian intern for Cheerful Hearts Foundation, also joined us, but it was basically on me to be the authority in the room, and I think things went very smoothly. Later in the day I got a group of us interns onto two separate trotros and managed to direct our cab driver back to our house when he didn’t know the junction for the general area where we are (we’ve only been in the new house for two weeks), so by the end of the day I was feeling very accomplished and ready to handle anything in Ghana.

I’ve been getting some dresses made by a seamstress that is friends with Douglas, including one with a kente print cloth which is going to be ready first. I’m stoked. Once I have these, I’ll really feel like I belong here… just in time for me to pack up and go home a few weeks later. I can’t believe the time is winding down so soon. I’m excited for the rest of my summer, especially since my dear friends will be getting married, but I’m going to miss Ghana terribly, and I’m seriously thinking about looking for a job out here and coming back after I graduate.

Research struggles

If you've read my posts from early this year, you know my original plan was to be conducting survey-based research in Vietnam this summer. That didn't quite work out, so I found the project in Ghana, but I never gave up on the research idea completely. I just had to find a focus and develop a proposal.

Four weeks in, I finally had a solid idea of what I could do. We've been doing school education about malaria, but we really have no awareness of how effective our campaign is, either for increasing knowledge about malaria or for the larger goal of actually preventing cases about malaria. So, for the past week I've been fleshing out the details of how to go about the project, writing surveys to give (there are three, one before the talk, one a week after, and one six months later), drafting consent forms for parents, students, and school administrators, and gathering all of the necessary information about schools in Kasoa. It's been incredibly busy. In the meantime I've also been at least making an appearance at the hospital every day (although many people noted that I hadn't really been around), giving a few school talks with Grace, and trying to do some sightseeing and visiting friends. I'm exhausted.

But the proposal is just about complete now, and being reviewed by my advisor tonight. If all goes according to plan it will be submitted tomorrow for IRB approval and because it's all survey based and not about a sensitive topic, can hopefully be rushed through approval and I can get started on the actual research component by June 25. There's plenty to do in the meantime, still, like coding all the surveys, getting data entry documents set up, and writing basic code for analysis that I can just import my data into later. And, of course, spending more time at the hospital and continuing with the already scheduled school talks.

Over the weekend we said goodbye to Amanda, and it's weird that she's not with us anymore. We had a little goodbye party for her with cake and grape juice, and she tried to cook for us... but had some struggles with metric system measurements. We went around to a few of the landmarks in Accra on Saturday before we had to say our fond farewells and part ways.

We miss you, Amanda!

Angie and Amanda "Azonto" dancing to Eric's beats

After dropping Amanda at the airport, we went to Osu, the "Las Vegas" of Accra (I'm not convinced) where Meghan, Grace, and I spent the night because we were going to an expat party in the area. We grabbed some food and drinks and lounged about for a while before Eric took off to leave the foreigners to their partying. We told him that next weekend we'll go out on Friday instead so that he doesn't have to leave because he's worried about waking up for church the next morning.

Accra at night

The expat party was an interesting affair - many more older attendees than I was expecting, and less dance-y than I was hoping. We stayed long enough to have awkward conversations with people we weren't remotely interested in and realize that we weren't particularly impressed with the whole thing. I did run into Elizabeth, who I'd met with the UU group on my first night in Ghana and had been meaning to email, so it was good to get a chance to talk to her.

After leaving the expat party we made our way first to a club that had a strict "no flip flops" policy, and then to another that said not to do it but this time was okay. I was starting to get tired and again there was a lack of dancing, so Grace and I didn't stay too long and went back to the hotel after a detour to KFC (the only chain I've seen in every country I've ever visited) and got some late night eats.

The next morning, I met Joseph, the UU guide from the first week, to head back to Odumase and visit the queen mothers and the children again. I'd meant to bring photos of the children from our school visits, but had some difficulties with printing. So when we got there we had about four hours to kill... which I used to coax some adorable children (I think the oldest was 6) to come sit with me and took more photos with them. I guess I'll just have to go back another time :)

My young friends in Odumase

Religion in Ghana

Brief disclaimer: I apologize if I have stated anything inaccurate about particular people in this post. I'm trying only to describe my experiences and perceptions, and I hope I have not accidentally said anything to offend anyone on this somewhat delicate topic. It's also quite long, so kudos if you make it all the way through.

Ghana is a very religious country. To my knowledge, it’s not institutionalized in any way, and officially there is religious freedom, but most people are some variant of Christian. And if they aren’t Christian, they’re probably Muslim.

I am not Christian. In the US, this has never been a cause for alarm for anyone that I know, or at least, any alarm that has been felt has never been expressed to me. My exploration of religious beliefs started a long time ago, is quite convoluted, and is still unfinished. I have trouble articulating exactly what I believe, and no currently defined religions, to my knowledge, exactly match me. But I’ll get into that later.

When I arrived in Ghana, it was with a group of Unitarian Universalists, or UUs. We were visiting children the UU church is financially supporting, their schools, and the Queen Mothers of the Lower Manya Krobo district who oversee much of the day-to-day business of the project. Although we discussed how our work in Ghana related to our values, it had little bearing on us otherwise during that week. The children struggled to pronounce the name and probably did not understand what it meant, just that they were being financially supported. The only people who asked us about our church and our faith were local expats, and the questions were a lot like what I've heard in the US.

This is the “church” (I use quotes both because it does not fall within most peoples’ ideas of churches, but also because many groups of UUs choose not to use that term for their congregations/fellowships/societies/etc) that I grew up in. My family first started attending when I was five or six years old, having heard about it from the parents of one of my classmates. My parents, who had both been raised in Christian households, had not felt the same connection to the Christian faith and became Quakers in their early adult life, and had a Quaker wedding ceremony. When they moved to California, however, whether because of me or because they did not find a fellowship that they liked, or something else (feel free to chime in her, Mom and Dad), they were not active in the Quaker society. But when introduced to Unitarian Universalism, they found that the ideas matched their own and quickly found a spiritual home among the members of the congregation.

As a child, it mattered little to me where I went to church. I didn’t really understand that it was different. I started with a belief in heaven and hell and God the Almighty, but over the years I became skeptical. I remember being shocked when my mom told me her beliefs when I was about six or seven, and effectively described herself as agnostic, with a belief that “God is in all of us” (I remember this part exactly) but I think meaning something similar to what I have come to believe, that there is some sort of energy, or life force, that moves through all people and all things, but is not a separate, omniscient entity.

But let’s come back for a moment to the concepts of Unitarian Universalism, which did not in any way proscribe that I give up a belief in heaven, hell, and God the Almighty, and instead only offered me the opportunity to explore other ideas. The seven core principles, which I was taught repeatedly as a child and have internalized in how I view the world, are given below. These concepts have so become part of who I am that even though I took an approximately 10 year hiatus from the UU church, when I read them again during my recent re-exploration of religion, I was stunned that they matched my feelings so well. As stated on my convenient description card, which I have taken to carrying with me everywhere, they are:

We, the member congregations of the Unitarian Universalist Association, covenant to affirm and promote:

The inherent worth and dignity of every person	The living tradition we share draws from many sources:
Justice, equity, and compassion in human relations	Direct experience of that transcending mystery and wonder, affirmed in all cultures, which moves us to a renewal of the spirit and an openness to the forces which create and uphold life
Acceptance of one another and encouragement to spiritual growth in our congregations	Words and deeds of prophetic women and men which challenge us to confront powers and structures of evil with justice, compassion, and the transforming power of love
A free and responsible search for truth and meaning	Wisdom from the world’s religions which inspires us in our ethical and spiritual life
The right of conscience and the use of the democratic process within our congregations and in society at large	Jewish and Christian teachings which call us to respond to God’s love by loving our neighbors as ourselves
The goal of world community with peace, liberty, and justice for all	Humanist teachings which counsel us to heed the guidance of reason and the results of science, and warn us against idolatries of the mind and spirit
Respect for the interdependent web of all existence of which we are a part	Spiritual teaching of Earth-centered traditions which celebrate the sacred circle of life and instruct us to live in harmony with the rhythms of nature

Grateful for the religious pluralism which enriches and ennobles our faith, we are inspired to deepen our understanding and expand our vision. As free congregations we enter into this covenant, promising to one another our mutual trust and support.

For me personally, the first and last carry the most weight. These two principles best describe the resulting respect that is due to all things because of this life force that I believe moves through all things. These are the ones I focus on in my life, although the rest generally fall into place because of them.

This past semester, I took a class on Asian religions and ecology. In the public health school, the potential role of religious organizations for promoting healthy behavior had come up in several classes, I was feeling a need to explore religion again, and whether because I grew up in the UU tradition or because I grew up in the eco-hippie dense San Francisco bay area or a combination of both, I was also feeling a need to tie it all in to ecology and ways of preserving our environment. After spending last summer in Vietnam and seeing the complete lack of care for the environment that is pervasive in the community there, and at the time I chose my classes still planning to go back, I was particularly intrigued by the fact that the class was about Asian religions. I’d also felt most closely connected with the Asian religions that I’d learned about in my younger years, and wanted to learn more.

The class, and the concepts I learned from each religion, forced me to think a lot about my own beliefs. I reconsidered the Christian idea of God. I contemplated Hindu deities, the Buddha, and the Dao. Each time we came to a new religion I thought “Aha! Now this is what I’ve believed all along!” until I got to the next and that more closely matched. That was true until the very last – Daoism – which came right after Confucianism. I think I’m some mesh of the two, so maybe China is where I would find the most people like me. The idea of the Dao is that which cannot be named but moves through all things and provides the impetus for the development of consciousness in humans. It is something akin to God, although it is not ascribed any awareness. It simply is. “He who names the Dao does not know the Dao.” I agree with many of the teachings in the classical and infamous text, the Dao de jing (Tao te ching, etc.), which speak of caution, simplicity, and kindness.

From Confucianism I draw the beliefs in the importance of education and careful thought, that striving for learning leads to better understanding and powerful, stable elevation within society. To be sure, there are other ways to get to the top, but the ways of Confucian benevolence will get you to a stable point of power, one that will not suddenly crumble. Develop loyalty and all will want to follow; use force and when the opportunity arises, all will turn against you. But my favorite Confucian text is called the Western Inscription. It was hung on the western wall of the scholar Zhang Zai as a reminder of the things to follow in life. I have abridged it to focus on the parts that have the most impact on me, and I have been meaning to paint it onto a canvas and hang it on the western wall of my own room in New Haven. This is my edited version:

Heaven is my Father

and Earth is my Mother,

and even such small creatures as we

find intimate shelter in their embrace.

Therefore that which fills the universe

I regard as my own body,

and that which directs the universe

I consider as my own nature.

All people are my brothers and sisters,

and all things are my companions.

Honoring those who are advanced in years

is to treat the elderly as elderly should be treated.

To be kind to the orphaned and weak

is to treat the young as the young should be treated.

All persons in the world who are tired, crippled, sick,

or who are brotherless, childless, widows or widowers

are my own siblings who have become helpless

and have none to whom they can appeal.

To care for them at such times

is the practice of a good child.

Wealth, honor, blessings and benefits

are meant for the enrichment of my life;

while poverty, humble status, worries and sorrows

are meant to help me find fulfillment.

In life I follow and serve Heaven and Earth;

In death I will be at peace.

I’ve sort of glossed over it up to this point, but growing up UU meant that I was introduced to all of the major world religions. On Sunday mornings, while other little children were taught bible stories exclusively and our parents listened to sermons about doing good in the world, my peers and I were taught the basics of Christianity, Judaism, Islam, Buddhism, Hinduism, etc. We visited other places of worship as a part of this exploration – the fourth UU principle given above – and were left to determine for ourselves what we thought the truth of life was. I’ve never felt shortchanged, but I never really firmly established beliefs. I think I just looked at it as unknowable. This past semester, during my re-exploration, I found certain texts that I agreed with, but came to similar conclusions.

But that’s not a sufficient for Ghana. Once I was on my own, people started asking me questions about my religion.

In a country where just about everyone believes in God, if you say you don’t, you need to be able to explain yourself. I’m not very good at it. People express a concern for my soul, and try to convince me that God exists by asking who created me, where I came from. I’ve taken to politely turning the question around and asking where God came from and stating simply that the idea of an omniscient creator does not make sense to me.

I’ve been asked what I think when I see people praying, singing hymns, reading the bible. My honest answer, which I have said, is that I think if it is important to the person doing it, then it is important to do. And I don’t rule out the possibility of an omniscient deity, it just doesn’t quite fit with my own perception of the world. I could be wrong. The other thing I tell people is that for me it doesn’t matter – I live my life under the same principles, practicing generosity when I can and kindness toward others; I am practically incapable of lying (which is somewhat problematic when people ask me about my relationship status, but that’s a story for another post) and I see theft of any sort as wrong. I think I live very morally, regardless of whose definition is used, and I cannot believe in the existence of a judgmental deity so strict that living as a good person but failing to have faith would prevent me from whatever eternal salvation may exist. I believe compassion and the way we treat others is of paramount importance, and not just for the potential eventual judgment day. Cultivating that attitude within oneself leads to honest and true relationships with other people that are based on trust and integrity and not easily broken, and our lives are completely dependent on how we interact with others. Judgment does not only come from the almighty but from all around us. 

Kumasi, Kakum, and Cape Coast

Early Saturday morning, Amanda and I set out for Kumasi. We left the house sometime between 5 and 5:30, waking Douglas only with the intent of making sure he had the keys after we walked out, but he insisted on accompanying us to the tro tro station. We had planned to take a tro tro into Accra and catch a larger bus there for the longer journey to Kumasi, but when we got to the station there was a tro tro heading straight for Kumasi, so we boarded that instead, but I wish we hadn’t. It was very cramped, so that by the time we arrived, I was hurting everywhere, and the driver was more than a little reckless – I thought we were going to die more times than I can count on both hands. But we arrived in one piece and made our way to the hotel we had picked out.

After dropping some of our things in our room, we headed out to explore Kumasi. We had three planned destinations – the cultural center, the Asantehene’s palace, and the Ghanaian version of the sword in the stone – legend has it that if it is ever removed, the state will fall apart. We made our way through the cultural center – highlights below – and then found a place for lunch. We were headed to the Asantehene’s palace but had to pass through the infamous (and very hectic) market, and Amanda got fed up, so we got in a taxi and went back to the hotel. I spent some time reading by the pool, got a plate of spaghetti from the hotel restaurant, and was asleep by 9pm!

The drums were amazing!

Drum making in progress

Some cool masks and other wood carvings...

Because I fell asleep so early I woke up astonishingly early, too, at 4:30am, before my alarm. We left the hotel around 6 and caught a tro tro to Cape Coast, and were directed by the driver to a taxi who would take us to Kakum. We agreed on 70 cedi for the trip, but didn’t quite have enough, so we went to the bank to get more money, and as we were pulling away from the bank, the driver hit another taxi! He hit an open door, then yelled at the person who had the door open (even though it was his fault), damaging the driver side door in the process to the point that it wouldn’t close. He knew he had lost us for himself, but he called a man he described as his senior brother, who then served as our personal driver for the rest of the afternoon, to Kakum, Hans Cottage, Cape Coast Castle, and back to the station.

On the road to Kakum

At Kakum National Park we did the canopy walk. After a steep hike up to the platform we stepped onto the walkways constructed from cables, ropes, wood planks, and a few bolts to hold it all together. One of the women in our group, a Ghanaian, was petrified of heights and took a few tentative steps onto the walkway and came back. She managed to cross the first bridge (there were 7 total) but couldn’t handle more and started crying, too scared to go on or go back. We passed her and made our way around the semicircle, and by the time we got back, she had disappeared.

Amanda on the canopy walk. Let's go!

Fearless Amanda!

Beautiful view of the rainforest, out over the canopy

No pictures of me on the walkway (yet) but I survived it!

After Kakum we stopped briefly at Hans Cottage Botel, a hotel that has a restaurant and a lake with over 50 crocodiles! We took a few pictures, watched some of them getting fed (from a safe distance!) and moved on to our next destination, the castle.

Oh, hello, Mr. Crocodile... please stay on that side of the barrier!

Glad I'm not in the water...

We joined a tour that had just started and saw the men’s and women’s dungeons, what’s left of the tunnel they went through to the ships, the hall where auctions were held, the officers’ quarters, and the door of no return. After the chilling reminder of some of the worst years of human history, we returned to the station and boarded a bus back to Kasoa.

Entering the dungeon

View from the top

Ahh, home, sweet, home. It’s good to be back.  

Outreach Education!

During my first week at my placement in Kasoa, I was working at the hospital for maybe 4 hours/day, helping with preventative care, which is only given to infants and small children and consists of registration, weighing, immunizations and vitamin A supplements, and on a volunteer basis, family planning (or different forms of birth control) and voluntary counseling and testing for HIV (VCT). The same department at the hospital also handles outreach, which includes education in the community and trips to the field to do the same preventative work for children that we do at the hospital, and during my second week I got involved with some of that.

On Monday and Tuesday I went out into local communities to talk with them about malaria and cholera, which mostly ended up with me listening and failing to understand while the others from the hospital talked about the diseases in Twi, the local language. I’m starting to learn a few key phrases, but I think it will still be a while before I can talk about malaria or cholera. I did speak in English a few times on Monday, and one time what I said was translated into Twi, and the second time I was speaking to a group of schoolchildren who could understand my English fairly well. However, I apparently left a lot out… I need some more practice talking about these issues in a way that is relevant to the local population.

Talking to Walantu village women who are smoking fish

Wednesday I was back at the hospital and tallying for each child that came in for weighing – whether they were new or had previously attended, and below one year, between 1 and 2, or over 2 years. There were none over two years, and few above age one. It was a hectic day, but still, most of the visitors had cleared out by noon. The hours officially continue until I think 3pm, but I have never stayed that late because there is nothing for me to really do at that point.

It was fortunate that they were all gone by then, despite the craziness earlier in the day, because that afternoon I went to Maranatha Preparatory School to give a talk to 7^th and 8^th grade students about malaria. I’d made a powerpoint for my own reference, then written out my notes, gone over them a bit with Eric… but never practiced the actual talk. So I arrived somewhat apprehensive about speaking to an unfamiliar type of audience, particularly since I knew very little about the background they would have on the topic, but feeling confident at least that I knew what I would talk about.

Writing some key concepts on the board

Answering a student question

The talk went reasonably well, especially since it was my first one, but there’s definitely room for improvement. I think the students learned a little bit from me, although I don’t know how much of what they repeated at the end was from what I told them or their own prior knowledge – they definitely threw in things I hadn’t talked about. Eric recorded the whole talk and I will be reviewing it before my next one, so I can figure out where I can make changes and get through to the students more effectively.

I also talked with Raul and Eric about additional work that I can do – the hospital is always finished by noon or 1, and even when I am there I don’t feel like I’m contributing very much, so I’m going to begin designing a full health education curriculum that I can use in different schools in the area and that can also be used by future volunteers. I’ve downloaded articles and reports from the ministry of health about previous health campaigns and the most significant diseases in the country and the general plan for reducing morbidity. I also downloaded articles about health education ideology and methods and I will try to set up my new curriculum based on these. To start, I’m focusing on malaria, TB, HIV, and cholera, but it may be later expanded.

There’s also a huge opportunity now with the school education work to do some data collection – try to assess what they know prior to the talk, what they have learned after the talk, and what they retain 1, 3, 6 months later (timeframe TBD). I’ll set this up in conjunction with Eric and Raul and have to get it approved by Yale before I can begin, but I think this can actually produce some interesting results, and give an assessment of how much people know in general.

Thursday I went to Adom, another small village near the hospital, to do outreach weighings and immunizations. We had about 10 children in the 2.5 hours we were there, much less than the same amount of time at the hospital. One of the children had some sort of skin infection/rash that looked like it could have potentially been measles, but the child was to young to receive the immunization, and received no additional care or referral about the rash. I also thought it was interesting that although one mother came with both a young child (less than one year) and one who was maybe about 2 years (still within the age that they should have gotten monthly weighings), only the younger child was weighed, and the nurse that I was with made no comment about the other child not being weighed.

Friday, today, is African Union day, and so Amanda and I have decided to take advantage of the holiday and take the day off from work. But I’m still trying to get a bit of work done; I’ll be looking over some of the documents I mentioned earlier and trying to develop new talks.

This weekend we are off to Kumasi for a day, then to Cape Coast and Elmina castles and Kakum National Park to see some wildlife and walk across the canopy bridge!

Beginning to adjust

Nothing here is as straightforward as in the US.

Getting to work either requires waiting for Eric to drive me, or soon, walking for 20-30 mins through the parts of Kasoa where the poorest live, to shouts of “Obruni” while dodging rocks that threaten to trip me, piles of trash, and rivulets of questionable liquids. Returning likewise is a question of waiting for a ride, which sometimes may be as much as 3 hours.

Looking toward my path to work from the Cheerful Hearts Foundation office (off to the left)

Ordering food usually does not happen off of a menu but instead happens by seeing what is available and requesting it or pointing to it. Or by going with the nurses from work and letting them order for me.

I live about an hour outside of Accra by tro tro, which is a delightful shared taxi van. People squeeze in and out for a very small fee (yesterday’s trip into Accra was only C1.20, or ~$0.65), and it’s hot and sweaty and full of a rich variety of odors. It’s important to tell the “mate”, who handles the money, when you want to get off, and know where that stop is.

Today I finally bit the bullet and did laundry. I’ve been spoiled all of my life. I have never appreciated my washing machine as much as I do today; I will never look at my pile of dirty laundry the same way again. When it means washing by hand in water that I don’t even want to wash my face with, my definition of “dirty” changes completely. However, there were some things that actually were dirty and HAD to be washed. Unfortunately, when I first decided it was necessary, I had no “washing powder”! So, while out yesterday, I picked some up at a gas station convenience store. Whew. And so it begins.

Washing my clothes by hand!

Hanging to dry

Amanda, a fellow volunteer, and I had to be taught by Douglas, who is a local that is also staying with our official host, Eric, how to wash our clothes. He filled buckets for us and added the appropriate amount of washing powder, and under his advice we threw our clothes in and left them to soak for about 15 minutes. Then we went back in to scrub, scrub, scrub. The process is fairly obvious after that – rinse, wring out, hang to dry, but wow, I had no idea how much work it was! Love love love the washing machine. Miss it so much.

Yesterday Amanda and I met up with Adam, a classmate of mine from Yale, one of his friends from Michigan, and several other current Michigan students. We met at Labadi Beach Hotel for lunch, and it was a wonderful escape at a heavenly oasis of air conditioning and Western food. Ahh. 

The beautiful pool at Labadi beach hotel

View of the beach from the hotel

We tried to go to the National Museum after, but it was closing 20 minutes later, so we didn’t go in. Unfortunately, the malaria exhibit they have is leaving on Monday, so I may miss it :(. We then went back to Circle, the main tro tro stop coming from outside of Accra, and walked around for a while. During our lunch, a big storm had come through, and we had seen the rain and wind and briefly the power went out, but it wasn’t until we got to Circle that we saw the real damage. A large tree had come down, huge signs had blown over, and some of the makeshift shelters that covered many of the small stalls selling various goods had collapsed. Adam and the other Michigan students left us, and Amanda and I went to the Holiday Inn to again savor air conditioning for a while, while we waited for Eric to pick us up after dropping another person at the airport. Though we didn’t get back until late, I was glad for the ride and the chance to avoid another tro tro. 

But it's not all bad. The sunsets can be quite pretty :)

Wednesday's Child

I see you looking at me. I know you're out there, but I get no comments. Not a ton of page views, but I'm not famous... yet. Eric, the cofounder of Cheerful Hearts Foundation, is trying to change that, though. He wants to start a new campaign for health and sanitation to go on TV - and says he expects me to be interviewed. Yes, Jennifer Du Mond will get her 15 minutes... on Africa TV.

Back to our regularly scheduled programming.

First, a poem:


Monday's child is fair of face
Tuesday's child is full of grace,
Wednesday's child is full of woe,
Thursday's child has far to go,
Friday's child is loving and giving,
Saturday's child works hard for a living,
But the child who is born on the Sabbath Day
Is bonny and blithe and good and gay.



At the hospital they alternately call me Jen, Akua (sp? sounds more like Akwiyah, but that’s not what the internet tells me), or Obruni. Sometimes a combination – I’ve also gotten Akua Obruni. Jen is obvious and Obruni simply means “white person” – I’ve been encouraged by at least one person to respond by saying “obibini”, which means “black person”. Akua is the reason for the poem – it’s a Twi name that means I was born on Wednesday, in other words, “Wednesday’s child”.

At the hospital the nurses are very friendly, sometimes too much. I’m never left alone for a moment, even when I say I want to go explore for food on my own. That just leads to “what do you want?” and someone accompanying me to get whatever I say sounds okay… even though I really did just want to wander around. They’re especially concerned about me getting enough to eat. They all want to feed me. It’s the first time I’ve consistently had people telling me I don’t eat enough. I’ve had some problems with a probable esophageal ulcer the last 6 months or so, and the nurses have seen me taking meds for it, and they told me the reason I have the ulcer is because I don’t eat. And if I don’t eat enough, they think they don’t like Ghanaian food. There are a few things I’m not terribly fond of (fufu is kind of weird, it’s just sticky dough), but for the most part I really enjoy the flavors. My Clif bars they call sweets and don’t think they’re enough to eat, and they aren’t convinced yet that I can handle the sachets of water like everyone else, and instead buy bottles for me. It’s just the first week, though, I’m sure we’ll figure things out.

This first week so far I’ve spent two days in the infant/young child area. I spent the first day just helping with baby weighings, which involves a bag with leg holes and a hanging scale, some very complacent babies and some that are very unhappy to be suspended in this way. On day 2 I did a bit more, starting with tallying for neo-natal immunizations (BCG and, if they come in the first two weeks, polio) and then going to registration. I spent more time asking questions on my second day, frustrated by how little I had learned on my first day. At the immunization station, I noted that although they are only supposed to give polio to infants that show up in the first two weeks since birth (the reasons for this are unclear to me), occasionally the infant was given polio vaccine anyway – but the nurse administering it did not want me to tally that for the epi records or note it in the child’s health records, which seems like a huge flaw in the system that will introduce gross inaccuracies about vaccine stores and records. I didn’t stay there long.

When I moved to the registration area I learned more about the general vaccine schedule. BCG is given as soon as possible after birth. I want to look into this more – with any vaccine there is concern that maternal antibodies present for the first 6 months after birth can reduce the ability of the child to develop their own antibodies, and a live attenuated vaccine (like BCG) carries disease development risk in those with compromised or underdeveloped immune systems. Polio is given within the first two weeks IF the child attends a clinic within that time, otherwise they start on a 3-dose regimen at 6 weeks (or as soon as possible thereafter), and then at 10 and 14 (or on successive visits). No other doses are potentially skipped. A pentavalent diphtheria-tetanus-pertussis-Hep B-Haemophilus influenzae B vaccine is given on the same dosing schedule as polio. I also want to check this, I think I remember hearing that this 5-in-one vaccine combo, instead of the 3-in-1 used in the US, plus separate Hib and Hep B, is less effective… but I’m sure it makes up for it in cost, and thus is preferred. Vitamin A supplementation is given starting at 6 months, and is given every 6 months after that until age 5. Measles and Yellow Fever vaccines are given at 9 months (when the immune system is fully developed). Pneumoccocal and rotavirus vaccines are given at any time if available – today the clinic ran out of stores of both, and I didn’t encounter a single record that already had a note that the child had received a dose of vaccine. These are also given in three doses. Children are supposed to come in once a month for weighing until 5 years, but few do. Weight for age is marked on a chart, and most children fall below the line indicating a “z-score” of 0 – meaning they are not necessarily malnourished, but certainly underweight for whatever the standard is. There is no indicator for height.

The books that all of this is recorded in is kept by the parents and is full of other important health messages, although I wonder how many parents actually read it, and if there is a huge lost opportunity to share health messages at these monthly visits. Part of the issue is that many do not speak English especially well, and many of the health messages are in English. And if they do speak it, they may not be able to read it (although those who do learn theoretically do so in school, where they are taught to read and write it as well as speak, and all instruction is in English).

Next week I start outreach education. There was some initial confusion about what my skills/plans were, but it should be sorted out now.

Wanted to post pics with this but haven't quite managed to get them! Hopefully tomorrow...

Week 1 - Accra and Odumase

Akwaaba.

I have only heard this once during my first few days, but all Ghanaian behavior certainly reflects the meaning of this Twi term, Welcome!

The flight was long, but survivable. I tried something a little different for jet lag, choosing to re-schedule my first meal on the plane for breakfast in my new time zone. I think it mostly worked, but the days have been so busy that I've been exhausted at the end of each day anyway.

Arrival went smoothly. Passport control was in some ways more intense than anywhere else I've gone (they took my picture and scanned my fingertips) and in some ways more lax (they didn't actually ask any questions). I collected my bags quickly, then waited probably for another 30 minutes until my mother managed to get hers. Only a few people were pulled aside for examination of bags, and fortunately, we weren't those people.

We met our guide, Joseph, and proceeded to the hotel. Ahh, to decompress. As with Vietnam, the pace here is a bit different from the US standard -  I told Joseph that I wanted to get a phone around 2:30pm, and between waiting for our driver to return and having lunch and then just some unexplained sitting around, we finally left at about 4:45. But the trip was successful, and I managed to get cash as well.

For dinner we were joined by two local ex-pats and more members of our delegation. We sampled some local food, and it was quite tasty - I hope the rest of it is this good! But, after a long 2 days of travel and a week prior to that with minimal sleep, I was exhausted.

On day two we met the Paramount Queen Mother of the Krobo people, the King of the Krobo, and had an extended audience with Manye Esther, the deputy to the Paramount Queen Mother, who is largely responsible for running the Every Child is Our Child program that our church is contributing aid money to. We had lunch with the Queen Mothers, saw performances from the kids the program is supporting, and visited a few of the homes of the children, then headed back to the hotel.



The kids singing for us


A few girls performing a traditional dance


The mother of two of the students supported by the program, herself disabled, receiving food gifts

We went back to the Krobo region the next day to meet with the school district officials and see the schools that the kids are attending. They were all laid out a bit differently, but had many things in common. Each asked for a library, and some pointed out the foundations that had been built for a library. They also wanted computers - three had been donated by a family on a previous trip, but only one school had electricity to charge the battery, and one computer had completely died. And the one school that had a useable computer said it wasn't enough to teach practical ICT (integrated computing and technology? something like that) to the 400+ students who are currently trying to learn it through drawings on a blackboard. Most buildings were run down, with little money available to support repairs, although our team leader, Bruce Knotts, could see that some improvements had been made since his last visit. We left them with gifts of pens and pencils, paper, books, soccer balls and frisbees, and a jar of candies. The kids and teachers were all very friendly, and many asked when we would come back, and if we could take them with us. I'm hoping to go back later this summer, with photos from my first trip, and maybe I will be able to spend some time with the kids then and really get to know some of them.



The foundation and some of the bricks for the unfinished library that will cost ~$15-20k to complete


A typical classroom, with the weekly schedule on the blackboard in the background


My sister and I with a group of kids at one of the schools

After visiting the schools we went to the local hospital to discuss the health coverage of the kids in our program and to find out if they are getting the yearly physicals they are supposed to be getting under our watch. The hospital mentioned several key difficulties - bed nets, although distributed free of charge, are often not used because it's much hotter to sleep under them; there has been a recent outbreak of Cholera; HIV is highest in this region compared to the rest of Ghana; and malnutrition, although low for Ghana, is still too high. Both the hospital and the schools had posters up about health and wellness, which I really liked. Far later in the day than planned on our schedule, we returned to our hotel in Accra.



One of the posters in the schools. Although a little simplified (vegetables are not ACTUALLY medicine), it gets the message across to eat more vegetables, which I liked a lot


An important message about sanitation and food handling!

On day four, called "dignitary day" by the group as a whole and "Jen day" by my family, I joined three other team members - Bruce, our leader, Peter Morales, the President of the Unitarian Universalist Association (UUA), and David Overton, who has been involved with the project since its inception and is on the board of an organization called Mercy Ships - to meet with the Peace Corps office here in Ghana. We discussed with them the value of having a peace corps volunteer stationed in Odumase, the major city near our project, and they told us about the work that they do here in Ghana. I took lots of notes and got a lot of great ideas for side projects during the rest of my time here. After the Peace Corps office we went to the embassy and met the Ambassador, who talked with us for several hours. More great notes. We expected to have lunch after meeting with the ambassador, but because he gave us so much of his time, we didn't have a chance before heading over to UNICEF, where we got a comprehensive breakdown of the health and education status of the children of Ghana. While most of us were at the meeting, Katrina, the trip coordinator, stopped at the supermarket to pick up snacks for us, so after the UNICEF meeting, we had some food before our next meeting with the Ghana AIDS Commission.

The Ghana AIDS Commission was probably my favorite meeting, whether because it was all about a subject I'm familiar with or because I'd just had snack and was fully awake or because I'd had practice from the other meetings, but I was finally able to ask pertinent questions in that meeting. A couple of the most striking things for me were that HIV testing is not mandatory for pregnant women, it is "opt-out", and only 4% of males and 7.8% of females know their HIV status. ARVs are not supported under the government health insurance, which makes them inaccessible to many of the country's poorest. It is no wonder, then, that most people choose to not get tested, when they can do nothing about it.

We finished out the day with about half of our group going to the family home of a former Peace Corps Volunteer who stayed in Ghana and now has a family here. They cooked dinner for us, chatted with us, and as with all of the other people that I met, they have offered any help they can give for the rest of my time here.

I was supposed to join the rest of the group for a trip to the former slave castles on Friday, but I caught a stomach bug which has kept me in bed now for nearly 48 hours. I can tell I'm on the mend, but not quite ready for the outside world. I may try to at least leave the hotel room (but not the hotel) in the next hour or so.

Tomorrow my family heads back to the US and I'm off to Kasoa where I'll be living for the next 10 weeks! And on Monday, I start my placement. I can't wait!!